title: Risk factors for ERCP-related complications in patients with pancreas divisum: a retrospective study.
abstract: BACKGROUND
  Limited data are available on complication rates of ERCP in patients with pancreas divisum (PD), and it is unclear whether traditional risk factors for post-ERCP pancreatitis (PEP) apply.
  
  
  OBJECTIVE
  To describe the rates of ERCP complications in patients with PD and assess patient and procedure-related risk factors for PEP.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  A total of 2753 ERCPs performed in 1476 patients with PD from 1997 to 2010.
  
  
  METHODS
  Rates of PEP, hemorrhage, perforation, cholecystitis, and hospitalization directly attributable to ERCP.
  
  
  RESULTS
  Early complications occurred after 7.8% of procedures, with PEP, hemorrhage, perforation, cholecystitis, and cardiorespiratory complications in 6.8%, 0.7%, 0.2%, 0.1%, and 0.1% of procedures, respectively. PEP was uncommon in patients who did not undergo attempted dorsal duct cannulation, occurring in 1.2% of procedures. With dorsal duct cannulation and cannulation with minor papilla sphincterotomy (MiS), the rates of PEP increased significantly to 8.2% and 10.6%, respectively (P<.01 for each comparison). Significant predictors of PEP after multivariate logistic regression included age younger than 40 (odds ratio [OR] 1.8; 95% CI, 1.27-2.59), female sex (OR 1.94; 95% CI, 1.25-3.01), previous PEP (OR 2.02; 95% CI, 1.32-3.1), attempted dorsal duct cannulation (OR 7.45; 95% CI, 3.25-17.07), and MiS (OR 1.62; 95% CI, 1.05-2.48). Presence of severe chronic pancreatitis was a protective factor (OR 0.46; 95% CI, 0.22-0.98).
  
  
  CONCLUSIONS
  Retrospective analysis of prospectively collected data.
  
  
  CONCLUSIONS
  Among patients with PD, the rate of PEP is low (1.2%) if dorsal duct cannulation is not attempted. However, patients with PD undergoing dorsal duct cannulation with or without MiS are at high risk of PEP (8.2% without and 10.6% with). Traditional PEP risk factors apply to patients with PD.
authors.affiliation: Indiana University, Indianapolis, Indiana, USA. dmoffatt@sbgh.mb.ca
authors.forename: Dana C
authors.initials: DC
authors.lastname: Moffatt
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Coté
authors.forename: Haritha
authors.initials: H
authors.lastname: Avula
authors.forename: James L
authors.initials: JL
authors.lastname: Watkins
authors.forename: Lee
authors.initials: L
authors.lastname: McHenry
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.forename: Glen A
authors.initials: GA
authors.lastname: Lehman
authors.forename: Evan L
authors.initials: EL
authors.lastname: Fogel
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007196:Indiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities* / Q000000981:diagnostic imaging; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors